This application was submitted in response to NIAAA PA-06-097 "Parenting Capacities and Health Outcomes in Youths and Adolescents". Alcohol and other drug (AOD) abuse/dependence, suicidal behavior, and HIV infection constitute three significant public health problems. Adolescents seeking treatment for mental health problems are at significantly greater risk for the development of AOD abuse/dependence, suicidal behavior, and risky sexual behavior compared to non-psychiatric adolescent samples. Prevention programs that target these three often inter-related self-destructive behaviors among youth seeking community mental health treatment have not been tested. The primary purpose of this proposal is to develop a family-based cognitive behavioral protocol designed to prevent AOD use disorder, suicidal behavior, and HIV risk behaviors among sexually active teens receiving community mental health services and then evaluate it in a randomized Stage I trial. This protocol will be developed by integrating key elements from two federally funded intervention protocols, Dr. Esposito-Smythers'(PI) cognitive behavioral individual and family based protocol for the treatment of adolescent alcohol abuse and suicidality and Dr. Brown's (PI) HIV prevention program for teens in mental health treatment. There are three primary aims in this project: 1) develop a manualized AOD, suicide, and HIV prevention protocol for adolescents receiving community mental health treatment;2) pilot and refine the prevention protocol with 12 families;and 3) test this prevention protocol in a small randomized pilot trial. To accomplish these aims, a two step sequence of treatment development is proposed. Stage 1a activities include manual development, therapist training, and an open pilot trial. Stage 1b activities include a randomized pilot trial. One hundred twenty-five adolescents and their parents receiving community mental health treatment will be randomly assigned to the integrated prevention protocol or an assessment-only control condition as an adjunct to their outpatient mental health care. The prevention protocol will include attendance at two workshops and an individualized booster session. Outcome will be assessed at post-intervention, 6 month, and 12 month follow-ups. The long term objective of this research is to yield a comprehensive prevention program that can be used as an adjunct to mental health treatment in an effort to offset the developmental trajectory toward AOD abuse/dependence, suicidal behavior, and HIV risk behavior among youth with mental health problems. PUBLIC HEALTH RELEVANCE Adolescent alcohol and other drug (AOD) abuse/dependence, suicide, and HIV infection constitute three significant public health problems. Adolescents with mental health problems are at significantly greater risk for each of these self-destructive behaviors when compared to non-psychiatric adolescent samples. An integrated AOD, suicide, and HIV prevention program, delivered within community mental health centers, could offset the development of each of these outcomes among youth with mental health problems.